Bloodstream infections in hospitalized adults with dengue fever: Clinical characteristics and recommended empirical therapy

Ling-Shan Syue, Hung Jen Tang, Yuan Pin Hung, Po-Lin Chen, Chia-Wen Li, Ming-Chi Li, Pei Fang Tsai, Ching-Chuan Liu, Nan-Yao Lee, Wen-Chien Ko

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Abstract

Background: Dengue is an important mosquito-borne tropical viral disease and dual infection, though rare, has been regarded as a risk factor for severe disease and mortality. However, few studies focused on bloodstream infections (BSIs) and empirical antibiotic therapy rarely addressed. Methods: Dengue patients with concurrent or subsequent BSIs between July 1 and December 31, 2015 were included. Clinical information, laboratory data, and drug susceptibility data were collected. Results: Totally 80 patients, with an in-hospital mortality rate of 32.5%, were included and categorized into three groups. 32 patients in Group I (BSI onset within 48 h after admission), 32 in Group II (between 48 h and one week), and 16 in Group III (more than one week). Patients in Group I were older (mean age: 75.6 vs. 72.6 or 69.6 years; P = 0.01) and had a higher Charlson comorbidity index (3.1 vs. 1.8 or 1.9; P = 0.02) than those in Group II or III. Streptococcus species (28.9%, 11/38) and Escherichia coli (23.7%, 9/38) were major pathogens in Group I. Enterobacteriaceae (38.2%, 13/34) isolates predominated in Group II. Fatal patients more often received inappropriate empirical antibiotic than the survivors (61.5% vs. 35.2%; P = 0.03). According to susceptibility data, pathogens in Group I and II shared similar susceptibility profiles, and levofloxacin, cefepime, or piperacillin/tazobactam, can be empirically prescribed for those hospitalized within one week. Conclusions: BSI pathogens vary among dengue patients. For adults with dengue and suspected BSI hospitalized within one week, empirical antimicrobial agents are recommended.

Original languageEnglish
Pages (from-to)225-232
Number of pages8
JournalJournal of Microbiology, Immunology and Infection
Volume52
Issue number2
DOIs
Publication statusPublished - 2019 Apr 1

Fingerprint

Dengue
Infection
Therapeutics
Anti-Bacterial Agents
Levofloxacin
Mortality
Virus Diseases
Enterobacteriaceae
Hospital Mortality
Anti-Infective Agents
Streptococcus
Culicidae
Survivors
Comorbidity
Escherichia coli
Pharmaceutical Preparations

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology and Microbiology(all)
  • Microbiology (medical)
  • Infectious Diseases

Cite this

@article{01d87e1336bc4dc9b13dd153ba7937ad,
title = "Bloodstream infections in hospitalized adults with dengue fever: Clinical characteristics and recommended empirical therapy",
abstract = "Background: Dengue is an important mosquito-borne tropical viral disease and dual infection, though rare, has been regarded as a risk factor for severe disease and mortality. However, few studies focused on bloodstream infections (BSIs) and empirical antibiotic therapy rarely addressed. Methods: Dengue patients with concurrent or subsequent BSIs between July 1 and December 31, 2015 were included. Clinical information, laboratory data, and drug susceptibility data were collected. Results: Totally 80 patients, with an in-hospital mortality rate of 32.5{\%}, were included and categorized into three groups. 32 patients in Group I (BSI onset within 48 h after admission), 32 in Group II (between 48 h and one week), and 16 in Group III (more than one week). Patients in Group I were older (mean age: 75.6 vs. 72.6 or 69.6 years; P = 0.01) and had a higher Charlson comorbidity index (3.1 vs. 1.8 or 1.9; P = 0.02) than those in Group II or III. Streptococcus species (28.9{\%}, 11/38) and Escherichia coli (23.7{\%}, 9/38) were major pathogens in Group I. Enterobacteriaceae (38.2{\%}, 13/34) isolates predominated in Group II. Fatal patients more often received inappropriate empirical antibiotic than the survivors (61.5{\%} vs. 35.2{\%}; P = 0.03). According to susceptibility data, pathogens in Group I and II shared similar susceptibility profiles, and levofloxacin, cefepime, or piperacillin/tazobactam, can be empirically prescribed for those hospitalized within one week. Conclusions: BSI pathogens vary among dengue patients. For adults with dengue and suspected BSI hospitalized within one week, empirical antimicrobial agents are recommended.",
author = "Ling-Shan Syue and Tang, {Hung Jen} and Hung, {Yuan Pin} and Po-Lin Chen and Chia-Wen Li and Ming-Chi Li and Tsai, {Pei Fang} and Ching-Chuan Liu and Nan-Yao Lee and Wen-Chien Ko",
year = "2019",
month = "4",
day = "1",
doi = "10.1016/j.jmii.2018.11.003",
language = "English",
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pages = "225--232",
journal = "Journal of Microbiology, Immunology and Infection",
issn = "1684-1182",
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TY - JOUR

T1 - Bloodstream infections in hospitalized adults with dengue fever

T2 - Clinical characteristics and recommended empirical therapy

AU - Syue, Ling-Shan

AU - Tang, Hung Jen

AU - Hung, Yuan Pin

AU - Chen, Po-Lin

AU - Li, Chia-Wen

AU - Li, Ming-Chi

AU - Tsai, Pei Fang

AU - Liu, Ching-Chuan

AU - Lee, Nan-Yao

AU - Ko, Wen-Chien

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background: Dengue is an important mosquito-borne tropical viral disease and dual infection, though rare, has been regarded as a risk factor for severe disease and mortality. However, few studies focused on bloodstream infections (BSIs) and empirical antibiotic therapy rarely addressed. Methods: Dengue patients with concurrent or subsequent BSIs between July 1 and December 31, 2015 were included. Clinical information, laboratory data, and drug susceptibility data were collected. Results: Totally 80 patients, with an in-hospital mortality rate of 32.5%, were included and categorized into three groups. 32 patients in Group I (BSI onset within 48 h after admission), 32 in Group II (between 48 h and one week), and 16 in Group III (more than one week). Patients in Group I were older (mean age: 75.6 vs. 72.6 or 69.6 years; P = 0.01) and had a higher Charlson comorbidity index (3.1 vs. 1.8 or 1.9; P = 0.02) than those in Group II or III. Streptococcus species (28.9%, 11/38) and Escherichia coli (23.7%, 9/38) were major pathogens in Group I. Enterobacteriaceae (38.2%, 13/34) isolates predominated in Group II. Fatal patients more often received inappropriate empirical antibiotic than the survivors (61.5% vs. 35.2%; P = 0.03). According to susceptibility data, pathogens in Group I and II shared similar susceptibility profiles, and levofloxacin, cefepime, or piperacillin/tazobactam, can be empirically prescribed for those hospitalized within one week. Conclusions: BSI pathogens vary among dengue patients. For adults with dengue and suspected BSI hospitalized within one week, empirical antimicrobial agents are recommended.

AB - Background: Dengue is an important mosquito-borne tropical viral disease and dual infection, though rare, has been regarded as a risk factor for severe disease and mortality. However, few studies focused on bloodstream infections (BSIs) and empirical antibiotic therapy rarely addressed. Methods: Dengue patients with concurrent or subsequent BSIs between July 1 and December 31, 2015 were included. Clinical information, laboratory data, and drug susceptibility data were collected. Results: Totally 80 patients, with an in-hospital mortality rate of 32.5%, were included and categorized into three groups. 32 patients in Group I (BSI onset within 48 h after admission), 32 in Group II (between 48 h and one week), and 16 in Group III (more than one week). Patients in Group I were older (mean age: 75.6 vs. 72.6 or 69.6 years; P = 0.01) and had a higher Charlson comorbidity index (3.1 vs. 1.8 or 1.9; P = 0.02) than those in Group II or III. Streptococcus species (28.9%, 11/38) and Escherichia coli (23.7%, 9/38) were major pathogens in Group I. Enterobacteriaceae (38.2%, 13/34) isolates predominated in Group II. Fatal patients more often received inappropriate empirical antibiotic than the survivors (61.5% vs. 35.2%; P = 0.03). According to susceptibility data, pathogens in Group I and II shared similar susceptibility profiles, and levofloxacin, cefepime, or piperacillin/tazobactam, can be empirically prescribed for those hospitalized within one week. Conclusions: BSI pathogens vary among dengue patients. For adults with dengue and suspected BSI hospitalized within one week, empirical antimicrobial agents are recommended.

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U2 - 10.1016/j.jmii.2018.11.003

DO - 10.1016/j.jmii.2018.11.003

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